Doctors Lounge - Gastroenterology Answers

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Is it necessarily bile duct cancer (cholongial carcinoma)? Could it be something else? The doctor says he doesn't know, and it's hard to diagnosis the cancer w/o invasive scoping which only has 50-50 chance of finding it anyway. I have no pain or appetite loss or other symptom whatsoever, except for the last week have had generalized itching. The enlarged bile ducts were found in October (5 months ago) when I went to emergency room w/ a short bout (8 hours) of acute chills/fever, shaking, and vomiting. Nothing else was found to be wrong with me after a night of much testing and scanning, and I felt 100% better and went home. I had three of these short bouts in a 3 or 4-week period. There was NO pain associated w/ these bouts, and I still have no pain. The bouts were similar to a reaction to an infection, and they have not recurred in these past 4-5 months. There is no way of knowing if I have had the enlarged bile ducts for many years, or what my previous CA 19-9 was because never tested before. I will be 86 in May but, besides arthritis, have always been healthy, not a drinker or smoker. Only symptoms are the enlarged ducts, the CA 19-9 level, and now the itching. No jaundice. Any ideas you have are much appreciated!

Since you had no baseline CA19-9 level before this first test, it would indeed be difficult to make anything of this one test. A followup test, later on, might give some idea of whether or not there might be a pancreatic tumor. The scope testing would be pretty unpleasant, and since the first tumor marker test is basically of no use (although subsequent ones might be), it would probably be of little practical value to do the scope, compared with the risks and discomfort.

The symptoms actually sound a lot more like cholecystitis (gallbladder disease) than pancreatitis or pancreatic tumor. The itching suggests possible liver involvement, which would be consistent with gallbladder or mild liver disease. Since you're doing fine with the exception of the three bouts of relatively brief illness, and are generally symptom-free, I'd probably take a wait and see approach, and if these episodes repeat again you might want to look at possible gallbladder or liver problems as well as then have a followup CA19-9 check. Otherwise, I suspect you're okay.

I hope this is helpful to you. Good luck and please follow up with us here as needed.